madface

Is insurance paying for your arm lift also?

8 weeks post op. Haven't cheated a day. Too scared to mess things up again. I failed on so many diets before through my own fault. I am very good at self sabotaging. This time I am sticking to the book.

I have a hard time with getting my drinks in and I know it’s going to get worse when I go back to work. I used to drink over 80 oz a day now I struggle to get 32 oz. Any technique or tip you can share?

I honestly love her doctor’s plan. I think it makes sense to get as normal of a healthy and balanced eating style as possible. If you can learn and incorporate the style now, then it won’t be as shocking and worrisome later on. When you’re like a year or more post op going, “help I can eat 1200 calories, is this bad?” Type of thing.

But, I went into this knowing that’s what I wanted. I want to have a healthy and balanced eating style. I want a normal relationship with food. I don’t want to be on a super restrictive diet for the rest of my life. I don’t want to freak out if I eat bread or a dessert every now and then. To me, that just wouldn’t be sustainable or a healthy lifestyle.

I did have a horrible relationship with food and binged a ton. I like that I’m relearning how foods should be taken in and what a balanced diet really means. I’ve also discovered I love a lot of the healthy foods and I’m not super interested in the shitty foods. Probably because I’m so recently post op, but I think if I continue and make this habitual, it will (hopefully) stick.

Idk, anyway, I’m anywhere between 500-1000 calories a day. I’m trying to get closer to 1000 a day, but some days I’m just not successful. And that’s fine.


5’6”
25 yo
SW: 256
CW: 236.9

*12/04/2017*

My group says that eating less than 1000 calories will set you up to have a starvation metabolism that not only can halt weight loss, but also is correlated with less weight loss, and more weight regain in 10 year studies.....because your metabolism is reset to a sluggish starvation level that works against you when you start eating normally again. You really can't eat 600 calories a day forever without suffering malnutrition eventually.
My group's protocol was developed by a major medical research hospital (University of Michigan) and is being picked up by Ceadars-Sinai and Bethesda naval hospital this year due to it's superior performance in longterm studies and excellent reputation in the Bariatric research community.
There are still old-school doctors who push super low calorie diets post surgically. The weight loss is fast, and people are very happy with fast results. But they often don't last and can result in an unhealthy metabolism that can't handle normal levels of calories later...and eventually result in weight gain.
The newer approach is to advance people to eating normal amounts of calories as soon as possible, so that they have the energy to add exercise and boost their metabolisms into athletic fat burning furnaces that last a lifetime and help them eat sensibly and continue to lose weight.
My doctor: You get one chance to reset your metabolism with this surgery, why would you want to reset it to a starvation level that conserves every calorie?
My nutritionist says that eating under 1000 calories is correlated with more Hair loss, nutrient malabsorption, fatigue and stress. Fatigue and stress trigger cortisol...which again, is contraindicated for weight loss.
Everyone has their own approach to who they trust and why....
A lot of my family is in medicine. I tend to trust the research hospitals and the empirical data of solid studies rather than the hype of clinics that are more interested in making a buck. I'm much more convinced by a collaborative consensus of what provably is healthiest long term and works.
I've been eating 1000-1200 calories since week 3....very comfortably. I'm walking seven miles a day and feel terrific. The scale is moving down about two to three pounds a week and I'm off all my meds.
I am loving this new lifestyle:) And I can live with it long term. And that's really the goal in my mind....the forever habits I can live with.

It is okay. I had regret. I call it buyers remorse. It will make you rethink every life decision you made. However, I promise you being that I am 2 months post-op, it gets easier and you will feel better. Right now it is uncomfortable and the pain maybe unbearable but do know it gets betters. I do not regret it now at all.
Remember, this is a non refundable transaction, you cannot take it back. You can only think positive and push forward.

I finally struck a decent balance with my liquids and Protein today. I was panicked I'd not be able to get the full 64 ounces of Water in. They only asked me to do 4oz every hour. I thought to myself where would I sneak protein in? And where I live is dry and hot, I need all the liquid I can get in or I face high risk of dehydration. 48oz wouldn't cut it.
So far today I've managed :
7% carbs, 6% fat, 87% protein. I've totaled 320 calories.
I started off with 24oz of water this morning, which took several hours. Then switched to 2 cups (16oz) of free range organic chicken broth from Trader Joe's and and added 1 scoop of Bio Chem Natural flavor to it. Now I'm back to 24 more ounces of water with 2 scoops of Bio Chem Natural flavor, which hasn't much taste and is giving me what I need protein and liquid wise. Once I finish this, which will take several hours, I can do more clear water or jell-O if I choose.
For anyone wondering how to achieve the same, I hope this helps.
As for soreness, I managed three hours of sleep the evening of day 1 post/op before the aches wouldn't let me rest, so pulled an all nighter awake with toothpicks holding my eyelids up, and looking like some drugged out doper staring into my computer monitor lol
I still haven't slept but walked a bit, and I noticed while my gas went away thirteen hours post op, leaving me with a raw and sore abdomen, the walking helps get the abdomen muscles loosened up and does lessen the pain two days in - and that's hugely important as that's when the pain is most severe. There is no longer any drip to sooth and manage the pain. For anyone reading who hasn't had the surgery yet WALK, and as much as you can. Also try and sleep if you can, but don't be surprised if you can't, even with heavy drugs in you.

I was sleeved Feb 7, 2017. In efforts to capitalize as much as I can in the 1st year, I started really working out. I walk 5-10mi/day. My speed was 23min/no. Now it's 17min/no.
In efforts to keep the muscles I had carrying around the old weight, I started to carry a frame pack with 25lbs of kitty litter.
What are you all doing to get the weight off? Only monitoring the food? Did you pick up new hobbies?
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I had my NUT and a general appointment with the surgeon's assistant yesterday. Apparently my insurance will only allow 3 NUT appointments, but really--I'm okay with that. The SA tells me it's important not to rush the process, and I tried hard to just smile and agree, because he didn't seem to hear the part where I told him I've been working toward this for 2 years. I have to wait for my old clinic to get around to sharing my records with my new clinic, anyway and hard telling how long that will take. I also don't want to have surgery until after I've done another set of injections in my SI joints. Otherwise, going without NSAIDS won't be an option.
So I'm trying to just take one step at a time. The SA said something that lit a spark with me--it was along the lines that I must learn how to do things that will take care of me. So on the way home, I bought some small mailing labels, and I'm going to print up some that say "What are you going to do today to take care of you?" and each day, when I start my journal entry for the day, I'm going to paste that at the top of the page and write down one thing to do that day. It might be a nutritional goal or exercise or making appointments or even taking a nap!
Flutterfly, your vacation trip will help you get through the tough days after surgery. Take loads of pics and video so that you can play them back on a loop when you're feeling sore or tired!

Here I am at my highest and my lowest let me know what you think. Starting weight 387 current weight 230. Just bought my first pair of 36 jeans down from a size 50. And still losing yeah!!!!!!!!!!!!!!!!!!!!!!!!!!

I had 2 c-secs and recovered pretty quickly, was up walking the night of.... This was less painful then the c-secs in my opinion, the soreness is comparable but not the same incision pain, if that makes sense, I'm almost 2 weeks out and feel like I have more energy than before!

I am 1.5 weeks out from surgery and one of my biggest concerns from day one of starting this process is I don't have time to be "down and out" post-surgery. I have a 6 and 10 year old...both very active in various activities and I work full time. My husband is very supportive and helps out a lot around the house, but is gone roughly 12 hours/day during the work week so I'm primarily the one running from here to there, cooking and running the basic errands.
So my question for those of you with active, younger kids...how did you manage the first few weeks out from surgery? Did you find that having to try and keep up with the family helped you because you had to focus on other tasks or were you drained?

Dear UpandAtom
Your journey sounds similar to mine. I am in Missouri, just outside of St Louis, I finally had s surgery date of April 25th and started my pre-op liquid. I found out today my PCP has changed his mind and will NOT give clearance until I see a neurosurgeon regarding some MRI results of my neck and upper spine. I'm so frustrated with this roller coaster but I've come too far to turn around now. I too have knee replacements. 3 of them. Both knees were replaced when I was 40. My left was replaced again in 2011 which caused me spinal injuries and I became disabled. I am 52 and feel like this VGS will be the tool I need to turn my health and my life around. Do you have a date yet or is it done already?
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I have PCOS and I'm currently 5 months post op sleeve. I just recently started having issues with my hair falling out. However, the hair everywhere else has started growing in like crazy on my face, neck, and even my lower back! I've always had problems with the hair in those areas but it's been controllable. Now no matter what I do or how often it seems it just keeps coming in thicker and thicker. Anyone else experience this? Also, how long after your sleeve before you started ovulating?
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A sign in my surgeon's office says "Medicare Covers The Sleeve Gastrectomy" and since medicare is federal it should be the same in every state. As long as your surgeon accepts medicare, then they will be a primary payer for you. Other insurance would be secondary. I know this because I used to do medical billing. Thats why they said call your surgeon first and make sure he accepts it. There are no pre-requirements for the surgery either thru medicare, but your other insurance if you are not self pay may have some. Hope this helped ease your mind!

Hi everyone I'm new to the support group and so far I'm really liking what I'm reading. I do have some questions tho? I live in illinois and i have medicare and im trying to find out if anyone know if they cover the gastric sleeve? When i called the insurance they said call my provider and then they'll call the provider line to find out if I'm covered? Now I'm really lost i dont understand why they didnt know but they knew about the other surgeries, can someone please help im starting to get a little discourage

Oh - I was able to copy the email that Tricare sent me. Here it is:
Aloha,
Thank you for your question. The TRICARE Policy Manual does not specify a certain number of months that the beneficiary must have been unsuccessful under a supervised weight loss program, however, there a other clinical considerations that are provided as guidelines:
TRICARE Policy Manual, Chapter 4, Section 13.2 states:
__________________
4.0 POLICY
4.1 Bariatric surgery, using a covered procedure outlined in paragraph 4.2 is covered for the treatment of morbid obesity when all the following conditions are met:
4.1.1 The patient has completed growth (18 years of age or documentation of completion of bone growth).
4.1.2 The patient has been previously unsuccessful with medical treatment for obesity. Failed attempts at non-surgical medical treatment for obesity must be documented in the patient's medical record.
4.1.2.1 Commercially available diet programs or plans, such as Weight Watchers®, Jenny Craig, or similar plans are acceptable methods of dietary management, if there is concurrent documentation of at least monthly clinical encounters with the physician.
Note:These programs are not covered by TRICARE.
4.1.2.2 Physician-supervised programs consisting exclusively of pharmacological management are not sufficient to meet this requirement.
4.1.3 The patient has evidence of either of the following:
•A body-mass index greater than or equal to 40 kg/m2.
•A body-mass index of 35-39.9 kg/m2 with one clinically significant co-morbidity, including but not limited to, cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy, or pulmonary hypertension
___________________
Bariatric surgery for morbid obesity requires prior authorization from the managed care support contractor whose clinical reviewers ensure that TRICARE coverage criteria can be met based on accepted medical practice.
I hope this information is helpful.
Aloha,
Gertie F
TRICARE Regional Office West
Hawaii Operations

Do you have that doctor's information? Do you know if they accepted Medicare plans in addition to self pay?

Bcbs is 6 months and Medicare is 3 months.
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Are you sure it is 4 visits vs 90 days? Mine dates are/were- June 3 (1st session), July 15th (2nd session) August 8th (third session); however, I will not reach 90 days until September 3rd. So my 90 day appt or 4th visit is just a weigh in.
This is from the brochure:
Benefitsforthesurgicaltreatmentofmorbidobesity, performed on an inpatient or outpatient basis, are subject to the pre-surgical requirements listed below. The member must meet all requirements.
− Diagnosis of morbid obesity (as defined on page 62) for a period of 2 years prior to surgery
− Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs; see page 40 for our coverage of nutritional counseling services.)
− Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise
− Evidence that attempts at weight loss in the 1 year period prior to surgery have been ineffective
− Psychological clearance of the member’s ability to understand and adhere to the pre- and post-operative program, based on a psychological assessment performed by a licensed professional mental health practitioner (see page 97 for our payment levels for mental health services)
− Member has not smoked in the 6 months prior to surgery
− Member has not been treated for substance abuse for 1 year prior to surgery and there is no evidence of substance abuse during the 1-year period prior to surgery

Yes I do have 2 years at 206 lbs 5 ft 1 in. For BMI of 38. I feel pretty good about getting approval. Just wanted to see how it has gone for others. what phase are you in for surgery?

So most insurance will list these surgeries as not covered. However, if something is medically necessary and your Dr's can provide proof of that then you can submit for an authorization to get it done. Your surgeon would submit your medical history and outline why you need this. There's usually a standalone department that consists of nurses and Dr's that will then verify if you do qualify for the surgery. If denied you can appeal, twice I believe with most. I work insurance and I've seen things not covered, paid out by the insurance. Best of luck with it all. Sent from my SM-G935T using the BariatricPal App

If you call your insurer, you want to ask if wls is a stated exclusion . If so, you want to ask if their medical guidelines offer any criteria that can override the exclusion. Also, if your employer's plan is self funded you can ask your employer to request an exception on your behalf
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Also, if your employer's plan is self funded, you might want to try to talk the employer into intervening on your behalf. The employer can request the surgery be approved if you meet medical necessity
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